Editor's note: This is the fifth in a series of articles to take a closer look at projects that would be funded by a sales tax increase and three bond questions that will go before voters on election day July 30. Early voting is underway.

LAS CRUCES, n.m. >> For Doña Ana County residents in medical crisis -- think heart-attacks and car crashes -- ambulance service is a key link in getting them life-saving care.

And county officials say a proposed gross receipts tax increase to be decided by voters July 30 is needed to create a secure funding stream for the service and keep response times low, as the population and demand for the service continue to grow.

The tax -- an extra 25-cent charge on a $100 purchase -- also would pay for operations of the county's built-but-not-yet-opened Crisis Triage Center to help the mentally ill and expanded staffing for a proposed new city-county 911 call center.

$1.3 million cost

The county, which is obligated by the state to provide ambulance service, contracts with American Medical Response, a private company, to cover a region ranging from Garfield to Las Cruces to Chaparral to Sunland Park. It pays the company an annual subsidy of up to $1.3 million per year.

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That sum is meant to ensure well-staffed ambulances are available in the rural areas that might only see one or two calls for help per day and to boost the equipment standards in the vehicles, said Jamie Michael of the county's Health and Human Services Department. Also, it's meant to reimburse the company for services it provides that are never paid for by the patients, mainly the county's indigent residents, she said.

"It's ensuring that, regardless of the payer mix in our community, that everyone has access to high-quality ambulance service," she said.

About 21 percent of Doña Ana County residents had no health insurance coverage, according to 2011 U.S. Census estimates.

Joaquin Graham, operations manager for AMR in Dona Ana County, said the subsidy helps close the gap between the company's cost of providing the service and what it collects in billing.

"Inside New Mexico, and especially inside of Doña Ana County, what we collect or are reimbursed is not enough to offset the amount we spend running an ambulance service," he said.

Last year, American Medical Response responded to 23,500 calls for help in Doña Ana County, not all of which resulted in transported patients, Graham said.

Graham said he supports the proposed tax increase because the current source of revenue for the subsidy "has some fluctuation," and the tax revenue would stabilize that. And it would provide a source of funding to allow for the ambulance service to grow along with the population, he said.

"The ambulance service needs to be able to grow with the community and keep pace with the community," he said.

The response volume has grown about 3 percent per year for the last two years, Graham said.

Shrinking funding

The county has paid the ambulance subsidy from the Health Services Fund, which gets yearly payments from Memorial Medical Center, said Interim County Manager Sue Padilla. That amount, dubbed a "charitable contribution," was guaranteed at a yearly level of at least $4.5 million per year according to the terms of a 2004 long-term lease agreement with the hospital company, according to Padilla.

That yearly amount was separate from a one-time pool of $26 million to the county and separate from a second one-time payment to the county of $5 million, both of which also were received as part of leasing out the county- and city-owned hospital campus, county officials said.

The annual payment is required to be at least $4.5 million, but it has ranged up to $9 million in the past, Padilla said. Essentially, it's directed to the county, which, in addition to paying for ambulance services, uses it to support services at the local low-income clinics. The idea was that it's cheaper -- both for the county and the hospital -- to pay for treatment of minor health problems in the clinics, rather than at MMC's emergency room, where most patients end up if they don't have access to the clinics, according to Padilla.

But because of federal health-care reform, Padilla said the hospital is expecting to pay the county less than it has in the past. That means MMC's funding level could drop back down to the minimum level.

In light of that decline in the Health Services Fund, the proposed 1/4 of 1 percent tax hike would provide an alternative funding pool for the ambulance service, Padilla said.

"We need a secured funding source, and we always need to continue looking at ways to improve our system in the future," she said. "We have an excellent service now, but we always want to do something better for our residents."

Asked about their support for the tax, residents shared mixed opinions.

Jennifer Terrazas was favorable toward it: "We will absolutely support this. We must all vote 'yes,' so that the best, most up-to-date service for our citizens' well-being and safety is available at all times."

But other residents were not persuaded.

"I'll be voting 'no' for this sort of thing unless our city and state start doing all they can to oppose and slow Obamacare and help push it closer to being defunded," said Randy Lynch, via Facebook. "I have no problem supporting essential services as long as the need isn't being created by us rolling over to be victims in the first place."

AMR entered into a contract with the county in 2007 and is currently on a year-to-year renewal through June 2014. The gross receipts tax increase would pay for ambulance service regardless of which company is the provider, officials said.

County officials have also said some of the tax revenue could go to fund other county emergency responder services, as well.

Split

If the tax passes, it could generate up to $7.8 million per year for the county. It would cost residents countywide an extra 25 cents on a $100 purchase, excluding most medical services and food.

Doña Ana County commissioners in June OK'd a resolution that would split the revenue from the tax, if it's OK'd by voters: 53 percent would go to the expanded city-county 911 call center staffing, 26 percent would go to the Crisis Triage Center operations; and 21 percent would go to the ambulance and possibly other emergency response services in the county.

3 GO bonds

In addition to the proposed gross receipts tax increase, three GO bond issues appear on the ballot to pay for a new 911 center building, fairgrounds improvements and a facility to hold animals that are evidence in abuse and hoarding cases.

"The important thing, again, is that these are all public safety issues; they're all very important for each and every one of us," Padilla said.

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